Organization
D BRUCE WILSON MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD BRUCE WILSON MD (PRESIDENT)
(901) 725-4400
Entity
Organization
Contact information
Practice address
188 S BELLEVUE BLVD, #405, MEMPHIS, TN 38104-3416
(901) 725-4400
(901) 516-8996
Mailing address
188 S BELLEVUE BLVD, #405, MEMPHIS, TN 38104-3416
(901) 725-4400
(901) 516-8996
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD009123
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126945
—
MS
05
—
120197
—
TN
01
—
13799
BLUE CROSSBLUE SHIELD
TN
05
—
3386286
—
TN
05
—
3388
—
TN
01
—
4724230
CIGN
TN
05
—
511754
—
TN
01
—
89359
BLUE CROSS
AR
Enumeration date
06/27/2007
Last updated
08/22/2020
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